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Full text of "Rapid Population Growth Consequences And Policy Implications"

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The indirect effects of population growth upon health services are legion; the direct effects follow from (a) numbers of people to be served, (b) their age distribution, and (c) their geographic distribution. For various reasons, such as the frequency of disease at different ages, public perceptions of a doctor's utility, cost to the individual, and local norms regarding the kinds and frequency of health supervision at different ages, the utilization of doctors varies by age of population served (28, 29). There are also differences in utilization and large differences in availability of doctors between rural and urban locations (17, 18, 28, 30). In the absence of good data on utilization rates for LDC's, it is difficult to project or predict the effect of changes in age structure and urban-rural residence on health services in the next 20 years, even if those changes themselves could be accurately predicted. The data that do exist indicate that lower population growth would result in a decrease in doctor utilization as a larger proportion of the population slowly became aged 15 to 45 (a group with lower utilization rates), offset by an increase in doctor availability and utilization as a larger proportion of the population moved into cities. Further discussion of direct population growth effects here will be limited to those resulting from numbers of people.
Changes in the Past Decade
One other important consideration is actual experience with changes in levels of health services in the recent past. Perhaps the best data come from a special WHO report (21) which compares the physicianrpopulation ratios of various countries in 1955 and 1965. Data are available for thirty-one of the thirty-seven countries defined as LDC's for this paper and are included in column 4 of Table 3. In the thirty-one countries in 1955, there were 181,891 doctors and 1,017,700,000 people, or 17.9 doctors per 100,000 people. The thirty-one countries showed an average increase from 1955 to 1965 in their doctor:population ratios of 18.5 percent over the 1955 level. Three countries had increases in their ratio of physicians to population by over 100 percent of the 1955 level, four by over 50 percent, and seventeen by less than 50 percent; seven had no change or decreases up to 44 percent. The average increase in doctors per 100,000 population was 3.3. With two exceptions (U.A.R. and Korea), this change by individual country was less then 10 per 100,000 and in nineteen was less then 5. Most of the decreases were in newly independent African countries. For the same time period, the increase in ratio of physicians to population for the United States was 14.4 percent of the 1955 level or 18 doctors per 100,000 population.
The effect of population growth during the decade 1955-65 upon the numbers of new doctors actually required to achieve the increases in doctor: population ratios is shown in Table 6. The requirements for LDC's and the United States are taken as zero in the theoretical case of zero population